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The role of chronic pain in injury claims

I have acted on behalf of chronic pain sufferers and the compensation for such claims can be quite considerable. Despite this, chronic pain can develop as a consequence of a relatively minor injury. Many clients with chronic pain find it difficult to point to a source of particular pain or are unable to explain the reason for it. As a result, these claims can be controversial. Below I aim to explore some of the science behind chronic pain and why care should be taken so that it is not overlooked during the claims process.

Doctors accept that a proportion of patients do not recover fully despite having suffered a seemingly minor injury, such as a sprain or whiplash for example. The reason why brings to light an interesting connection between trauma, pain and the mind.

The level of pain a person feels at the time of an injury is not necessarily an indication of what the resulting disability might be. It is well known that people perceive pain differently. This has been shown in laboratory studies during which the same pain stimulus was administered to various subjects. They reported varying degrees of pain from ‘no pain’ to ‘the worst pain ever felt’. As people have different pain thresholds, the pain experienced at the time of an injury does not necessarily reflect the extent of any continuing damage. This explains, in part, why a seemly mild injury can have long-term implications not envisaged at the time of an accident.

A person’s fear of injury, prior experience of pain and their state of mind at the time of an accident can have important consequences as well. To prevent further injury or the associated feeling of pain, especially if the feeling of pain has been severe, an injured person might start to demonstrate avoidance behaviour such as avoiding going out or restricting activities generally. Avoidance behaviour often leads to further problems such as reduced performance at work and less time spent on positive activities like hobbies or socialising. This compounds the situation and makes recovery more difficult. An adverse psychological reaction may also be felt.

The link between pain perception and a person’s psychological state is well established. For example, if a person with a wound is stressed it can take longer for that wound to heal. Those who are stressed also process pain differently. Post-traumatic stress disorder (not uncommon with accident victims) can result in the injured person having a lower pain threshold compared to someone who is otherwise healthy. Pain, common responses to it (e.g. irritability) and a negative mood all share the same neurotransmitter pathways in the brain and are almost certainly linked. People who are psychologically unwell at the time of injury, or later develop such problems, have a different hormonal response to pain in that they release fewer endorphins, which are natural pain relievers, and therefore experience more pain. The individual’s nerve endings might actually become more sensitive as well, which rather than aiding recovery has the opposite affect.

It is easy to see why recovery can be prolonged once a person begins to demonstrate symptoms of chronic pain. If an injured person is excessively vigilant through fear of re-injury, focused on their pain and/or pessimistic as to the outcome or their future prognosis it may be that they are suffering from chronic pain.